SecondsCount Venous Disease Risk Assessment Checklist

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3/03/2013

Are you at risk for problems with your veins? Check off the items that apply and share your answers with your doctor. Together you can find ways to reduce your risk of developing problems in the future.

Check the box if you:

[ ] have family history of vein problems

[ ] are older, especially over age 70

[ ] are overweight

[ ] are pregnant or recently had a baby

[ ] have had or are experiencing hormonal changes, for example, pregnancy or menopause

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